Overview On Undescended Testicles: A Condition More Common in Newborns Than You Might Expect

In a male fetus, the testicles are formed in the abdomen during fetal development. Typically, during the eighth month of pregnancy, closer to delivery, these testicles move down a tube called the inguinal canal, which then leads to the scrotum, located beneath the penis. When one or both of the testicles fail to move down into the scrotum before birth, the condition is called cryptorchidism, commonly known as undescended testicles.

Testicles usually descend into the scrotum within 6 to 12 months after birth, but if this does not occur, surgery may be required. This condition is commonly seen in 3-4% of male infants and affects about 30% of premature babies, which translates to 1 in every 25 boys.

The exact cause of cryptorchidism is uncertain, but male infants who are at higher risk include premature babies, those with a family history of the condition, and those with low birth weight. The primary symptom of this condition is the absence of a testicle. The condition is usually diagnosed by a doctor during a physical examination shortly after birth. If left untreated, undescended testicles can lead to complications such as infertility, inguinal hernia, testicular cancer, and an increased risk of testicular torsion (twisting of the testicle).

Cryptorchidism can be classified into two main types. The first type includes palpable testicles, which can be felt during a physical examination. These include inguinal testicles, located in the inguinal canal, ectopic testicles, which are found in abnormal positions such as the thigh or perineum, and retractile testicles, which move between the scrotum and the groin. The second type includes non-palpable testicles, which cannot be felt during an examination and require imaging or surgery to locate. These include abdominal testicles, which are located in the abdomen, vanishing testicles, which disappear during fetal development, and absent testicles, which did not develop or are completely missing.

The treatment for undescended testicles usually involves surgery, which is typically recommended between 6 and 18 months of age. The type of surgery performed depends on the specific condition. Orchiopexy is done for palpable testicles, where the surgeon makes a small incision to locate the testicle, brings it down into the scrotum, and secures it in place. Laparoscopic surgery is done for non-palpable testicles, where small incisions are made to insert a camera and surgical instruments. This allows the surgeon to locate the testicle and bring it down to the scrotum. Laparoscopic surgery is less painful, involves faster recovery, and leaves smaller scars.

Fowler-Stephens orchiopexy is a two-stage surgery used to treat testicles located high in the abdomen that cannot be reached by one surgery. This procedure gradually allows the testicle to descend while maintaining proper blood flow. Orchiectomy is performed if the testicle is non-functional or poses a cancer risk; in this case, the testicle is surgically removed, typically in older children.

After surgery, recovery is generally quick, and most children can resume normal activities within 1 to 2 weeks. The child may experience mild discomfort and swelling, but this should subside over time. Follow-up appointments are essential to ensure proper healing. If your child develops a high fever or if the wound becomes infected, parents should immediately contact the child's surgeon.

General FAQs on Undescended Testicles (Cryptorchidism)

The condition is highly treatable, and surgery has a high success rate. Early detection and intervention can help prevent complications. If parents notice any concerns about their child's testicular development or if they suspect an undescended testicle, they should consult a pediatric surgeon to discuss treatment options and ensure the best care for their child.